[Risk stratification of patients with diabetes mellitus].
BACKGROUND
This paper discusses the optimal distribution of responsibility between general practitioners (GPs) and hospitals for follow-up of patients with chronic diseases. We investigated a set of risk stratification criteria developed to optimize specialist shared care for patients with diabetes mellitus.


METHODS
We included patients with diabetes from the catchment areas of four diabetes out-patient clinics in southern Denmark. Patients were risk-stratified to 3 follow-up levels (level 1 - follow-up only by their GP, level 2 - intensified follow-up by GP and/or shared care schemes, level 3 - follow-up only in out-patient clinics). The results were subsequently compared with the patients' actual follow-up status.


RESULTS
A total of 647 patients (563 type 2 diabetes and 84 type 1 diabetes) were included from 15 GPs. Among these, 139 were stratified to level 1, 409 to level 2 and 99 to level 3. A total of 444 patients were actually being followed by their GP, 129 in shared care and 74 in out-patient clinics. The frequency of out-patient and shared care control varied from 13% to 39% between the four centres.


CONCLUSIONS
Patients generally had a higher risk profile than anticipated. The model could select high-risk patients to be followed in specialized out-patient clinics. The model was less suitable for patients with low or moderate risk, and it should be modified before its general introduction.
Qvist
Peter
P
Center for Kvalitet, P.V. Tuxensvej 5, DK-5500 Middelfart. Peter.Qvist@regionsyddanmark.dk
Glintborg
Dorte
D
Andries
Alin
A
Hansen
Christian
C
D003718:Denmark; D048909:Diabetes Complications / Q000517:prevention & control; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000628:therapy*; D005194:Family Practice / Q000592:standards; D005500:Follow-Up Studies; D006801:Humans; D010044:Outpatient Clinics, Hospital / Q000592:standards; D011785:Quality Assurance, Health Care; D018570:Risk Assessment; D012307:Risk Factors